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Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases
G Habib1, C Tribouilloy, F Thuny
1Department of Cardiology, La Timone Hospital, Marseilles, France. gilbert.habib@ap-hm.fr
Heart (British Cardiac Society)
|June 17, 2005
Summary
Prosthetic valve endocarditis (PVE) carries high mortality. Severe heart failure and Staphylococcus aureus infection predict in-hospital death, while early PVE, co-morbidity, severe heart failure, staphylococcal infection, and prosthetic dehiscence predict long-term mortality.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Prosthetic valve endocarditis (PVE) is associated with significant morbidity and mortality.
- Identifying prognostic markers and optimal treatment strategies is crucial for improving patient outcomes.
Purpose of the Study:
- To determine prognostic indicators of poor outcomes in patients with PVE.
- To evaluate the impact of medical versus surgical management on PVE outcomes.
- To identify patient subgroups who may benefit from surgical intervention.
Main Methods:
- A multicenter study involving 104 patients with PVE.
- Analysis of in-hospital and long-term mortality.
- Multivariate analysis and Cox proportional hazards modeling to identify predictors of mortality.
- Comparison of outcomes between medical and surgical treatment strategies.
Main Results:
- In-hospital mortality was 21%, with severe heart failure and Staphylococcus aureus infection as independent predictors.
- Long-term mortality predictors included early PVE, co-morbidity, severe heart failure, staphylococcal infection, and prosthetic dehiscence.
- Overall mortality did not differ significantly between surgical and non-surgical groups.
- Surgical intervention reduced both in-hospital and long-term mortality in high-risk subgroups, specifically those with staphylococcal PVE and complicated PVE.
Conclusions:
- PVE presents a high risk of both in-hospital and long-term mortality, necessitating close patient follow-up.
- Congestive heart failure, early PVE, staphylococcal infection, and complicated PVE are associated with adverse outcomes.
- Early surgical intervention is strongly recommended for patients with staphylococcal PVE and complicated PVE, as it is associated with improved outcomes in these specific subgroups.